
<h2>Registration</h2>

<form action="<?php __e(site_url('welcome/thankyou'));?>" method="post" name="frmreg" id="frmreg" class="frmreg">
  <table border="0" cellpadding="0" cellspacing="0" class="frm_geneal_det">
    <tr>
      <td>
        <input type="radio" name="rd" id="rd" class="padup" />          
        <label><strong>Static IP</strong> address used by our institution</label>
        <span class="example">Example: 192.168.1.2.0</span>
        <input type="text" name="txt1" id="txt1" value="" maxlength="20" />
      </td>
    </tr>
    
    <tr>
      <td>
        <input type="radio" name="rd" id="rd" class="padup" />          
        <label>We dont have <strong>Static IP</strong> address, please issue a password based login</label>
      </td>
    </tr>
    
    
    <tr>
      <td>
        <input type="radio" name="rd" id="rd" class="padup" />          
        <label><strong>Static IP</strong> address will be provided later</label>
      </td>
    </tr>        
  </table>
  
  <table border="0" cellpadding="0" cellspacing="0" class="frm_com" width="100%">
    <tr>
      <td width="49%" class="frm_col_left">
        <table border="0" cellpadding="0" cellspacing="0" class="frm_inst_details">
          <tr>
            <td colspan="2"><h3>Institutional Details</h3></td>
          </tr>
          <tr>
            <td><label for="">Unique ID/Code</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>
          <tr>
            <td><label for="">*&nbsp;Institution Name</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>
          <tr>
            <td><label for="">*&nbsp;Address1</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>          
          <tr>
            <td><label for="">Address2</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>          
          <tr>
            <td><label for="">*&nbsp;City</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>
          <tr>
            <td><label for="">*&nbsp;State</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>
          <tr>
            <td><label for="">*&nbsp;Postcode</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>
          <tr>
            <td><label for="">*&nbsp;Country</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>
          <tr>
            <td><label for="">*&nbsp;Email</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>          
          <tr>
            <td><label for="">*&nbsp;Phone</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>
          <tr>
            <td><label for="">Fax</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>
        </table>
      </td>
      <td class="brdspace">&nbsp;</td>
      <td width="49%" class="frm_col_right">
        <table border="0" cellpadding="0" cellspacing="0" class="frm_invoice_details">
          <tr>
            <td colspan="2">
              <h3>Invoice Details</h3>
              <div class="info">
                <input type="radio" name="rd" id="rd" class="padup" /><label>Same as Institutional Details</label>
              </div>
            </td>
          </tr>
          <tr>
            <td><label for="">*&nbsp;Name</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>
          <tr>
            <td><label for="">Delegation</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>
          <tr>
            <td><label for="">Unique ID/Code</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>
          <tr>
            <td><label for="">*&nbsp;Institution Name</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>
          <tr>
            <td><label for="">*&nbsp;Address1</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>          
          <tr>
            <td><label for="">Address2</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>          
          <tr>
            <td><label for="">*&nbsp;City</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>
          <tr>
            <td><label for="">*&nbsp;State</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>
          <tr>
            <td><label for="">*&nbsp;Postcode</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>
          <tr>
            <td><label for="">*&nbsp;Country</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>
          <tr>
            <td><label for="">*&nbsp;Email</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>          
          <tr>
            <td><label for="">*&nbsp;Phone</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>
          <tr>
            <td><label for="">Fax</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>
        </table>
      </td>
    </tr>
    <tr>
      <td colspan="3" align="right">&nbsp;</td>
    </tr>  
    <tr>
      <td width="49%" class="frm_col_left">
        <table border="0" cellpadding="0" cellspacing="0" class="frm_admin_details">
          <tr>
            <td colspan="2"><h3>Administrative/Library Contact Details</h3></td>
          </tr>
          <tr>
            <td><label for="">*&nbsp;Name</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>
          <tr>
            <td><label for="">Designation</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>          
          <tr>
            <td><label for="">Department</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>                    
          <tr>
            <td><label for="">*&nbsp;Email</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>          
          <tr>
            <td><label for="">*&nbsp;Phone</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>
          <tr>
            <td><label for="">Mobile</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>
          <tr>
            <td><label for="">Fax</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>
        </table>
      </td>
      <td class="brdspace">&nbsp;</td>
      <td width="49%" class="frm_col_right">
        <table border="0" cellpadding="0" cellspacing="0" class="frm_tech_details">
          <tr>
            <td colspan="2">
              <h3>Technical Details</h3>
              <div class="info">
                <input type="radio" name="rd" id="rd" class="padup" /><label>Same as Administrative/Library Contact Details</label>
              </div>
            </td>
          </tr>
          <tr>
            <td><label for="">*&nbsp;Name</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>
          <tr>
            <td><label for="">Designation</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>          
          <tr>
            <td><label for="">Department</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>                    
          <tr>
            <td><label for="">*&nbsp;Email</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>          
          <tr>
            <td><label for="">*&nbsp;Phone</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>
          <tr>
            <td><label for="">Mobile</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>
          <tr>
            <td><label for="">Fax</label></td>
            <td><input type="text" name="txt1" id="txt1" value="" maxlength="20" /></td>
          </tr>
        </table>
      </td>
    </tr>
    <tr>
      <td colspan="3" align="right">&nbsp;</td>
    </tr>  
    <tr>
      <td colspan="3" align="right">
        <input type="submit" name="btn_reg" id="btn_reg" value="" class="btnreg btnpad"/>
        <input type="reset" name="btn_reset" id="btn_reset" value="" class="btnreset btnpad"/>
      </td>
    </tr>
  </table>
</form>
